Organization
MARYLAND SPORTSCARE & REHAB LLC
Active
Other names
PIVOT PHYSICAL THERAPY OF MARYLAND
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
844 WASHINGTON RD, SUITE 102, WESTMINSTER, MD 21157-6664
(410) 876-5600
(410) 876-1623
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(252) 248-3313
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160584
UHC
—
01
—
7914198
AETNA
—
01
—
T208
BLUECHOICE
MD
Enumeration date
08/31/2005
Last updated
11/01/2024
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